Tony.Wang: Created Holmium Laser Enucleation of the Prostate

2024-03-15T19:27:57Z

Created Holmium Laser Enucleation of the Prostate

New page

{{Infobox surgical procedure
| anesthesia_type = GA
| airway = LMA vs. ETT
| lines_access = 1 PIV
| monitors = Standard ASA monitors
| considerations_preoperative =
| considerations_intraoperative = Keep patient still during lasering and morcellation to avoid inadvertent tissue damage
| considerations_postoperative = Prostate bleeding is common
}}

Holmium laser enucleation of the prostate is a surgical treatment for benign prostatic hypertrophy (BPH).

== Overview ==

=== Indications ===
Benign prostatic hypertrophy (BPH)

=== Surgical procedure ===
A Holmium laser device is inserted via the urethra to remove prostate tissue.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|Postrenal obstruction resulting in hydronephrosis and elevated BUN/Cr from BPH is common
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===
BUN/Cr can sometimes be elevated if patients have hydronephrosis from BPH.

=== Operating room setup ===

=== Patient preparation and premedication ===
N/A

=== Regional and neuraxial techniques ===
The procedure can be done under spinal with moderate sedation if there is contraindication to GA or if strong patient preference. It is very important that the patient does not move during the procedure, so careful patient selection must be performed.

== Intraoperative management ==

=== Monitoring and access ===

* Standard ASA monitors
* 1 IV is sufficient

=== Induction and airway management ===
LMA or ETT are both options. If there is more prostate tissue to remove, higher risk of bleeding, the surgeons may request ETT with full paralysis.

=== Positioning ===
Supine, lithotomy

=== Maintenance and surgical considerations ===
Patients need to be kept still to avoid inadvertent lasering of tissue. At the end of the case, the prostate tissue that has collected will be run through a morcellator device, which is inserted at the end. This has the highest chance of causing inadvertent damage if the patient is not kept still.

=== Emergence ===

== Postoperative management ==

=== Disposition ===
Typically, PACU and home the same day. Patients can go home with a catheter still in place.

=== Pain management ===

=== Potential complications ===
The prostate tissue is very vascular and can result in post-op bleeding. Patients are typically monitored with continuous bladder irrigation (CBI), which can dilute even large amounts of bleeding, causing delay in treatment.

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Indications
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]

Holmium laser enucleation of the prostate - Revision history

Tony.Wang: Created Holmium Laser Enucleation of the Prostate